Q: What is a MassHealth Prior Authorization?
A: A MassHealth Prior Authorization enables MassHealth to review, assess, approve, modify, or deny selected non-emergency medical services prior to payment.
Q: How do I apply for MassHealth authorization?
A: Once your doctor sends us the necessary paperwork documenting your illness or need, we compile all of the required forms to apply for MassHealth authorization to cover your supplies.
Q: How long does it take MassHealth to respond?
MassHealth usually responds with their decision within 2-3 weeks.
Q: Will I automatically be approved?
A: MassHealth will either approve, deny or modify your request.
Q: What happens if I am approved?
A: We will contact you to verify your order and address. Your supplies can be sent out immediately.
Q: What happens if I am denied?
A: We will notify you. Sometimes denials are a result of incomplete paperwork. If that is the case, we will contact your doctor / caregiver to attempt to get the necessary forms. Your Decision Notice will have instructions to appeal a denial.
Q: What happens if it is modified?
A: We will contact you to verify delivery of the approved supplies.
Q: How long is my authorization good for?
A: MassHealth will provide an Expiration Date on your Decision Notice. The maximum time allowed for an approval is one year.
Q: What if my insurance changes while my Prior Authorization is still pending?
A: If you are no longer eligible for Mass Health, you can not receive services or supplies, even if they give a Prior Authorization.
Call Mass Health Customer Service if you have any questions about your Mass Health eligibility. Visit Mass Health Customer Service Contact Info or call MH customer Service at 800-841-2900.
Q: Does it matter if I switch my MassHealth coverage to Network Health?
A: If you switch your existing Mass Health insurance coverage to a Managed Care Organization (for example: Network Health, BMC Healthnet or Neighborhood Health Plan) we need to apply directly to those plans, as they have different requirements for authorization. Let us know immediately if you make such a switch.
Q: I need different supplies than the ones on my authorization. Can you simply switch them?
A: If your supply needs have changed, a new authorization from MassHealth is required.
Q: Will my authorization automatically renew?
A: When your authorization expires, you will need to submit a new authorization request. You should begin this process up to 2 months before the expiration of your current authorization, to ensure all of the necessary paperwork is submitted. This will help ensure there is not a gap in your supply delivery.
Please call us with any questions 877-942-4276.